“I think of (Obamacare) as giving everyone an ATM card in a town where there are no ATM machines,” Stanton said. “The coming storm of patients means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”
What happened in Massachusetts in 2006 when the state’s mandated health insurance rules went into effect illustrates the impending national problem.
When the Massachusetts law kicked in, wait times to get an appointment at primary care physicians’ offices increased significantly, and they’ve remained high ever since, according to an annual survey from the Massachusetts Medical Society. And Massachusetts has the second highest physician-to-population ratio of any state.
When patients couldn’t get doctor’s appointments they once again turned to emergency rooms. A Harvard study found all 11 of the emergency rooms that researchers studied in Massachusetts became busier after the law went into effect.
The Affordable Care Act does try to address some of the problems. There’s an additional $1.5 billion in funding allotted for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a shortage (physician numbers are particularly stretched thin in rural areas).
The law also puts more money toward training in hopes of increasing the primary care workforce. It offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015. The law’s emphasis on coverage for preventive care may also mean fewer people will need to visit doctors for more serious issues down the road.
Blackwelder is optimistic that this problem will be the prompt the system needs to address these long-standing issues with our medical system. He admits, though, that he’s a “glass-half-full kind of guy.”
He suggests existing technology could help. Not all patients actually need to see him personally; if there is a way to set up an online system so patients could access records, e-mail simple questions or request prescription refills, that would cut down on the amount of time they’d have to spend in his office.
Blackwelder also thinks a team approach would be more productive in health care practices — something many hospitals are already trying to adopt.
“In Kingsport, Tennessee, where I work, I’m happy to see patients, but we also have a health department or retail clinics that people could go to for their flu shots or other treatments,” Blackwelder said. “And if we maintained good communication with those other providers we could also avoid duplication of services and increase our overall effectiveness.”
Qualified nurse practitioners might also be able to lighten some of the primary care physicians’ load, as would physician’s assistants if such practices are allowed. But in some states that are already desperate for doctors, such as Mississippi, nurse practitioners must legally practice under the guidance of a physician.
Other solutions could include opening more residency slots for doctors. Blackwelder said he’d also love to see universities discount tuition for students who studied primary care.
“I’d love for them to say to a student, ‘I hear you are interested in primary care,’ and present them with a bill with only zeros on it,” he said. “And then say to people who were going into a specialty, ‘Here’s your tuition bill,’ with a number in front of all those zeros.”
“I understand there is a sense of worry, and change can be scary, but our present system is broken,” Blackwelder said. “We pay twice as much for our health in this country and have worse outcomes than other countries.
“We will have to start coming up with creative solutions to this problem — ones that won’t have to wait for an act from Congress.”
Jen Christensen | CNN